HMS Holdings Corp. hit the red ink in the fourth quarter thanks to the lingering standstill in Medicare's recovery audit program, but growing Medicaid contracts offered the company some relief.
Hospital leaders are working to head off any momentum in Congress toward overhauling Medicare rates to pay hospitals the same for outpatient services as the program pays for the same services in physician offices.
The fee-for-service payment model for healthcare treatment may be withering, but there's little hard evidence that alternative payment models such as accountable care organizations will provide better care at a cheaper cost, experts agreed in a forum convened by the Federal Trade Commission.
The first round of ICD-10 end-to-end testing yielded positive results for how the CMS handled claims but a mixed picture for how providers and others are doing in properly submitting claims.
The CMS has either identified or prevented more than $210.7 million in healthcare fraud in one year using predictive analytics. But critics want to see the agency do much more with its new digital tools.
DaVita HealthCare Partners anticipates a $100 million reduction in its 2016 operating income if the CMS finalizes proposed changes to Medicare Advantage rates.
CMS interim leader Andy Slavitt apparently is putting together his senior team as the departure of Administrator Marilyn Tavenner draws closer.
The CMS plans to more closely monitor Medicare Advantage insurers' provider networks and may fine or otherwise sanction plans that don't accurately show which doctors are available at in-network prices.
Paula Ercolini is one of about 1.8 million seniors who are part of a Medicare Advantage advocacy group that is blitzing the airwaves and putting pressure on the Obama administration and Congress.
The CMS has proposed increasing health insurers' Medicare Advantage payments by 1.05% for 2016, a move that kicks off a 45-day dogfight in Washington before the rates are cemented.
The U.S. Justice Department has asked health insurer Humana for information related to its Medicare Advantage risk-adjustment practices, building off a whistle-blower case from several years ago, Humana said in a regulatory filing late Wednesday.
Universal American, a Medicare managed-care and accountable care operator, ended last year with smaller losses on its overall business and its accountable care organizations than those of the prior year.